8 Steps to Address Racial Bias in Healthcare

ECRI this year named Bias and Racism in Addressing Patient Safety as number three on its annual list of Top 10 Patient Safety Concerns. Racial and ethnic disparities have been well documented, and while some progress has been made, the problem is pervasive, persistent, and damaging.

These disparities affect:

• Patient access to care
• Patient safety
• Quality of care and clinical outcomes
• The frequency and consistency with which reports of adverse events are filed
• The level of responsiveness when adverse events are reported
• Patient health, well-being, and life expectancy

Research shows that patients who are members of racial and ethnic minority groups experience barriers that limit their access to care, and affect the quality of their care, more frequently than non-minorities; this includes having an increased risk of being uninsured or underinsured, lacking access to care, and experiencing worse health outcomes for conditions that are treatable and even preventable. 

Those conditions include diabetes, hypertension, asthma, obesity, heart disease, and more. As a result, members of racial and ethnic minority groups suffer with higher rates of illness and death. And the disparities infiltrate a wide variety of healthcare services.

Additionally, the Centers for Disease Control and Prevention reports, “…the life expectancy of non-Hispanic/Black Americans is four years lower than that of White Americans. The COVID-19 pandemic, and its disproportionate impact among racial and ethnic minority populations is another stark example of these enduring health disparities.”

Social determinants of health

The U.S. Department of Health and Human Services defines social determinates of health as, “…the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Five categories are identified including:

1. Economic stability
2. Education access and quality
3. Healthcare access and quality
4. Neighborhood and built environment
5. Social and community context

These factors have a major impact on people’s ability to get and stay healthy, to access healthcare, medicine, and healthy foods; to obtain quality housing; to access quality education; and to live without being subjected to personal and systematic discrimination affecting their lives and well-being.

Healthcare organizations should take action

To combat this serious problem, ECRI suggests that healthcare organizations implement policies designed to identify and eliminate racism and discrimination from within the organization. These include:

1. Recognize that racism and implicit biases may be present in your organization.
2. Examine the racial demographics of reported patient safety events and root-cause analyses performed by the organization for serious events. Determine whether racial or ethnic disparities exist in the types of events being reported and analyzed.
3. Train leaders on health equity and cultural competence, addressing topics that include health disparities, cultural competence, health outcomes among minorities, and other related issues.
4. Work with community partners to promote health professions among people of color and other disadvantaged populations, and increase efforts to recruit diverse clinicians and staff.
5. Perform health equity and cultural competence assessments. Repeat such assessments after implementing improvement initiatives and periodically thereafter.
6. Launch ongoing educational programs designed to develop healthcare providers’ cultural competence and cultural humility and to mitigate implicit bias.
7. Establish policies designed to meet patients’ cultural and linguistic needs from admission to discharge. Utilize resources from organizations such as Joint Commission and the U.S. Department of Health and Human Services (HHS).
8. Take seriously all allegations of racism, bias, or discrimination that originate from within the organization, and implement appropriate measures to thoroughly investigate and address such reports and to ensure that such reports are not closed out inappropriately.

Check back here for future blogs that will explore in greater detail ECRI’s research and recommendations on this important topic.

For more information today, read ECRI’s Deep Dive, Racial and Ethnic Disparities in Health and Healthcare Executive Brief, and reach out to us at clientservices@ecri.org to be connected to an ECRI expert.